Positive Thyroid Autoantibodies Research Articles

The effect of levothyroxine and prednisolone treatment on pregnancy in in vitro fertilization patients with positive thyroid autoantibodies.

To investigate the effects of levothyroxine and prednisolone treatment, or in combination, on positive thyroid autoantibodies in infertile patients undergoing in vitro fertilization (IVF) therapy. This retrospective study included a total of 190 patients with positive thyroid autoantibodies (anti-T and anti-TPO) who underwent IVF treatment between January 2008 and March 2016. Patients were divided into four groups: group 1-levothyroxine group (n = 50), group 2-prednisolone group (n = 50), group 3-levothyroxine and prednisolone combination (n = 25), group 4-control group (n = 65). Anti-T and anti-TPO levels before IVF and at the time of embryo transfer (ET), b-hcg positivity, clinical and biochemical pregnancy, miscarriage rate, and live birth rate were compared among groups. In levothyroxine-treated group, mean anti-TPO levels significantly decreased at the time of ET compared to before IVF treatment levels (p = 0.036). In group 3, mean anti-T and anti-TPO levels significantly decreased at the time of ET compared to levels before IVF treatment (p < 0.05). Patients who became pregnant in group 1, mean anti-T anti-TPO levels significantly decreased compared to before IVF treatment levels (p < 0.05). The biochemical pregnancy rate was significantly higher in group 2 (p = 0.03). Abortion rates were the highest in group 3, but no significant difference was found among groups. The group treated with levothyroxine had a significantly increased rate of live birth compared to the control group (p = 0.02). Levothyroxine addition during IVF treatment of patients with positive thyroid antibodies in subclinical hypothyroidism increases the take-home baby pregnancy rate. Whether subclinical hypothyroidism or not in IVF treatment, levothyroxine is more effective than low-dose corticosteroids.

Synergistic Interaction of Thyroid Autoantibodies and Ring Finger Protein 213 Variant in Moyamoya Disease.

Recently, thyroid autoantibodies were found to be associated with moyamoya disease (MMD). The ring finger protein 213 (RNF213) p.R4810K variant represents the most important susceptibility genotype of this disease, but its relationship with thyroid autoantibodies remains to be elucidated. Thus, in this study, we aimed to evaluate the clinical relevance of thyroid autoantibodies in each RNF213 genotype in patients with MMD. Included in this study were patients with MMD without a thyroid disease history and in euthyroid status; they were then classified into the mutated or nonmutated based on the RNF213 p.R4810K genotype and positive or negative based on thyroid autoantibody (thyroperoxidase and thyroglobulin) levels. Clinical data of each group were thereafter evaluated. Among the 209 patients, the mutated RNF213 p.R4810K variant and positive thyroid autoantibodies were detected in 155 and 41 patients, respectively. Positive thyroid autoantibodies were found to be more common in the nonmutated patients than in the mutated patients (31.5% vs. 15.5%; P = 0.011). In the mutated patients, as compared to autoantibody-negative patients, autoantibody-positive patients were determined to be more likely to have advanced disease with posterior cerebral artery involvement (54.2% vs. 29.0%; P = 0.017), white matter infarction (58.3% vs. 37.6%; P = 0.046), and a higher modified Rankin Scale at last visit (16.7% vs. 3.1%; P = 0.021). These results suggest that thyroid autoantibodies can act as an immunity inducer in patients with MMD lacking the susceptibility gene RNF213 p.R4810K variant. Moreover, the simultaneous presence of thyroid autoantibodies and the variant seems to aggravate the disease, which indicates synergy between thyroid autoantibodies and the variant.

The expression of GADA, ZnT8A and IA-2A in patients with type 1 diabetes mellitus with thyroid disease and their correlation with thyroid autoantibodies.

The aim of this research was to study the expression of anti-glutamate decarboxylase antibody (GADA), zinc transporter-8 autoantibody (ZnT8A), and insulinoma-associated protein-2 antibody (IA-2A) in patients with type 1 diabetes (T1DM) with thyroid disease (TD) and its correlation with thyroid autoantibodies. 380 patients with T1DM were included in the study, of which 313 patients with T1DM alone were included in the control group. In the TD group, 41 patients with T1DM and Hashimoto's thyroiditis (HT) were included, and 26 cases of T1DM patients with Graves' disease were included in the Graves group. The clinical features of the control group, the HT group, and the Graves group were compared. The positive rates of insulin autoantibodies in the control group and the TD group were analyzed. The clinical characteristics of patients with and without insulin autoantibody positivity were compared. The positive rates of thyroid autoantibodies in T1DM patients with positive GADA, ZnT8A, IA-2A, and different numbers of positive insulin autoantibodies were analyzed. The levels of total cholesterol (TC) and thyroid stimulating hormone (TSH) in the HT group were significantly higher than those in the control and Graves groups, and the levels of free thyroid hormone (FT4) and low-density lipoprotein cholesterol (LDL-C) were significantly lower than those in the control and Graves groups (p<0.001). The levels of TC and TSH in the Graves group were significantly lower than those in the control group, the levels of HbA1c, LDL-C, and FT4 were significantly higher than those in the control group, and the levels of FT3 were significantly higher than those in the control and HT groups (p<0.001). The levels of C peptide, triglyceride (TG), and LDL-C of insulin autoantibodies positive patients were significantly lower than those of negative patients (p<0.05). The positive rates of GADA, ZnT8A, and IA-2A in the TD group, as well as the positive rates of double antibodies and triple antibodies, were significantly higher than those of the control group (p<0.05). In T1DM patients, the positive rates of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in GADA and IA-2A-positive patients were significantly higher than those in GADA and IA-2A-negative patients (p<0.05). The positive rate of TPOAb in ZnT8A-positive patients was significantly higher than that in ZnT8A-negative patients (p<0.05). The positive rates of TRAb, TPOAb, and TGAb in T1DM patients positive for two of the three insulin autoantibodies and three insulin autoantibodies were significantly higher than those positive for one of the three insulin autoantibodies (p<0.001). TD can exacerbate the disorder of glucose and lipid metabolism in patients with T1DM, and multiple insulin autoantibodies positive T1DM patients it is more likely to have thyroid autoantibody positivity. It is suggested that patients with aggravated glucose and lipid metabolism and multiple insulin autoantibody positivity should be routinely screened for thyroid antibodies to help early diagnosis of TD.

Relationship between Iron Deficiency and Thyroid Function: A Systematic Review and Meta-Analysis.

Objective: Iron deficiency (ID) is the most prevalent nutritional deficiency worldwide. Low levels of serum ferritin (SF) could affect the thyroid gland and its functioning. The purpose of this systematic review and meta-analysis is to summarize the main currently available evidence and analyze data on the relationship between ID and thyroid function. Methods: This study included all articles evaluating the relationship between ID and thyroid function. Quality assessment was performed using Cambridge Quality Checklists. The search strategy included the following combination of Medical Subjects Headings terms and keywords: "iron deficiency", "thyroid function", "thyroid disease", "thyroid dysfunction", and "hypothyroidism". A meta-analysis was performed to evaluate whether thyroid stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels differed between patients with ID and healthy controls without ID. For statistical comparison between cases and controls, the mean difference (MD) was calculated, and a subgroup analysis of pregnant and non-pregnant women was performed. Cochran's Q testing and heterogeneity indices (I2) were used to assess statistical heterogeneity. Sensitivity analysis and publication bias analyses were also performed, both qualitatively and quantitatively. Finally, a meta-regression analysis was performed to evaluate the correlation between serum TSH or FT4 levels and SF in the study population. Results: Ten cross-sectional studies were identified and reviewed. Patients with ID showed TSH (MD: -0.24 mIU/L; 95% CI -0.41, -0.07; I2 = 100%, p = 0.005), FT4 (MD: -1.18 pmol/L; 95% CI -1.43, -0.94; I2 = 99%, p < 0.000001), and FT3 (MD: -0.22 pmol/L; 95% CI -0.32, -0.12; I2 = 99%, p < 0.00001) levels that were significantly lower. Subgroup analysis confirmed significantly lower TSH, FT4, and FT3 levels in pregnant women. Non-pregnant women showed significantly lower serum FT4 and FT3 levels but no difference in TSH values. Meta-regression analysis showed that serum TSH and FT4 levels were positively correlated with SF levels. Our systematic review of the literature found that ID significantly increases the prevalence of thyroid autoantibody (anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies) positivity both individually and collectively. Conclusion: Studies currently published in the literature indicate a possible relationship between ID, thyroid function, and autoimmunity, especially in some patient groups. Data analysis shows that thyroid hormone levels are lower in patients with ID and, in particular, in pregnant women. Further studies are needed to understand the role played by iron in thyroid metabolism.

Influence of thyroid autoimmunity at various clinical stages of hypothyroidism on the risk of miscarriage before 20 weeks of gestation

PurposeWe aimed to clarify the influence of thyroid autoantibodies at various clinical stages of hypothyroidism on the risk of pregnancy loss before 20 weeks of gestation.MethodsWe enrolled 230 pregnant women with a history of recurrent miscarriage. Detailed clinical history, physical examination, and laboratory testing of thyroid function, antithyroid peroxidase (anti-TPO), and antithyroglobulin (anti-TG) were applied among all participants.ResultsCoexisting overt hypothyroidism and positive thyroid autoantibodies quadrupled the risk of miscarriage in women before 20 weeks of gestation (OR 4.04, 95% CI = 2.08–7.96, P < 0.001). Women with subclinical hypothyroidism (OR 1.44, 95% CI = 0.81–2.57, P = 0.132,) or who were euthyroid (OR 1.53, 95% CI = 0.86–2.73, P = 0.094) showed a non-significant risk of miscarriage even with positive thyroid autoantibodies. Thyroid-stimulating hormone (TSH) was positively correlated with the number of miscarriages rather than anti-TPO (P < 0.001 and 0.209, respectively).ConclusionCoexistence of overt hypothyroidism and thyroid autoimmunity was the only significant driver of pregnancy loss before 20 weeks of gestation.

Metabolomic analysis of follicular fluid from women with Hashimoto thyroiditis

Hashimoto thyroiditis is an autoimmune disease characterized by hypothyroidism and a high level of anti-thyroid autoantibodies. It has shown to negatively impact female fertility; however, the mechanisms are unclear. Ovarian follicular fluid appears to be the key to understanding how Hashimoto thyroiditis affecst fertility. Thus, we aimed to evaluated the metabolic profile of follicular fluid and antithyroid autoantibody levels in the context of Hashimoto thyroiditis. We collected follicular fluid from 61 patients, namely 38 women with thyroid autoantibody positivity and 23 women as negative controls, undergoing in vitro fertilization treatment. Follicular fluid samples were analyzed using metabolomics, and thyroid autoantibodies were measured. Fifteen metabolites with higher concentrations in the follicular fluid samples from Hashimoto thyroiditis were identified, comprising five possible affected pathways: the glycerophospholipid, arachidonic acid, linoleic acid, alpha-linolenic acid, and sphingolipid metabolism pathways. These pathways are known to regulate ovarian functions. In addition, antithyroglobulin antibody concentrations in both serum and follicular fluid were more than tenfold higher in women with Hashimoto thyroiditis than in controls. Our data showed that the metabolic profile of follicular fluid is altered in women with Hashimoto thyroiditis, suggesting a potential mechanistic explanation for the association of this disease with female infertility.

The Joint Effects of Bisphenols and Iodine Exposure on Thyroid during Pregnancy.

The aim of this research was to study the combined effects of bisphenols and iodine exposure on the thyroid gland during pregnancy. We included 162 pregnant women from a cohort established in Shanghai. Urinary concentrations of bisphenol A, bisphenol B(BPB), bisphenol C(BPC), bisphenol F, bisphenol S, and bisphenol AF(BPAF) were examined. Bayesian kernel machine regression (BKMR) and quantile g-computation models were used. The geometric means of BPA, BPB, BPC, BPF, BPS, BPAF, and ΣBPs levels in urine were 3.03, 0.24, 2.66, 0.36, 0.26, 0.72, and 7.55 μg/g creatinine, respectively. We observed a positive trend in the cumulative effects of BPs and iodine on serum triiodothyronine (FT3) and free thyroxine (FT4), as well as a U-shaped dose-response relationship between BPs and the probability of occurrence of thyroperoxidase autoantibody positivity in women with low urinary iodine concentration. In addition, a synergistic effect on the probability of occurrence of thyroid autoantibody positivity was observed between BPF and BPB, as well as between BPC and BPAF in this study. There were adverse health effects on the thyroid after co-exposure to BPs and iodine. Even if pregnant women were exposed to lower levels of BPs, women with iodine deficiency remained vulnerable to thyroid autoimmune disease.

Prognostic value of preoperative thyroid autoantibodies for post-thyroidectomy patient pathology: A retrospective cohort study.

The aim of this study was to evaluate the clinical value of preoperative thyroid autoantibodies with reference to the post-thyroidectomy patient pathology. A retrospective cohort study. Two tertiary care academic hospitals. A total of (n = 473) subjects who underwent thyroidectomy from 2009 to 2019 were included. Preoperative serum thyroid autoantibodies (anti-thyroglobulin [anti-Tg] and anti-thyroperoxidase [anti-TPO]) were measured, and the potential predictors of postoperative pathological diagnosis (age, gender, and thyroid autoantibodies) were assessed using multivariable regression models. Patients with positive thyroid autoantibodies were more likely to have malignant disease than benign disease; adjusted odds ratio (AOR) = 1.6 (1.3-2.7, p = 0.002) for anti-Tg, and AOR = 1.6 (1.1-2.5, p = 0.027) for anti-TPO. A subset analysis of the same predictors performed on patients with cancer (malignant vs. microcarcinoma) showed that patients with ages ≥40 were more likely to develop microcarcinoma as opposed to malignant disease; AOR = 1.8 (1.1-3.1, p = 0.03) for anti-TPO, and AOR = 1.7 (1.0-2.9, p = 0.04) for anti-Tg. Preoperative thyroid autoantibodies could be used clinically to predict the risk of malignancy in thyroid nodules, thus helping guide treatment decisions in patients with thyroid nodules and speeding up the decision to undergo surgical intervention.

Thyroid Function Tests in Children and Adolescents With Trisomy 21: Definition of Syndrome-Specific Reference Ranges.

The lack of syndrome-specific reference ranges for thyroid function tests (TFT) among pediatric patients with Down syndrome (DS) results in an overestimation of the occurrence of hypothyroidism in this population. To (a) outline the age-dependent distribution of TFT among pediatric patients with DS; (b) describe the intraindividual variability of TFT over time; and (c) assess the role of elevated thyrotropin (TSH) in predicting the future onset of overt hypothyroidism. In this retrospective, monocentric, observational analysis, we included 548 patients with DS (0-18 years) longitudinally assessed between 1992 and 2022. Exclusion criteria were abnormal thyroid anatomy, treatments affecting TFT, and positive thyroid autoantibodies. We determined the age-dependent distribution of TSH, FT3, and FT4 and outlined the relative nomograms for children with DS. Compared with non-syndromic patients, median TSH levels were statistically greater at any age (P < .001). Median FT3 and FT4 levels were statistically lower than controls (P < .001) only in specific age classes (0-11 for FT3, 11-18 years for FT4). TSH levels showed a remarkable fluctuation over time, with a poor (23%-53%) agreement between the TSH centile classes at 2 sequential assessments. Finally, the 75th centile was the threshold above which TSH values predicted future evolution into overt hypothyroidism with the best statistical accuracy, with a satisfactory negative predictive value (0.91), but poor positive predictive value (0.15). By longitudinally assessing TFT in a wide pediatric DS population, we outlined the syndrome-specific reference nomograms for TSH, FT3, and FT4 and demonstrated a persistent upward shift of TSH compared to non-syndromic children.

Early warning signs of thyroid autoantibodies seroconversion: A retrospective cohort study

BackgroundSerum anti-thyroid peroxidase antibody (anti-TPO) and anti-thyroglobulin antibody (anti-Tg) levels are key indicators for the diagnosis of autoimmune diseases, especially autoimmune thyroiditis. Before the thyroid autoantibodies turn from negative to positive, it is unknown whether any clinical indicators in the body play a warning role. PurposeTo establish an early prediction model of seroconversion to positive thyroid autoantibodies. MethodsThis retrospective cohort study collected information based on clinical laboratory data. A logistic regression model was used to analyse the risk factors associated with a change in thyroid autoantibodies to an abnormal status. A machine-learning approach was employed to establish an early warning model, and a nomogram was used for model performance assessment and visualisation. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analyses were used for internal and external validation. ResultsLogistic regression analysis revealed that albumin to globulin ratio, triglyceride levels, and Glutamic acid levels among liver function and some metabolism-related indicators, high density lipoprotein C among metabolism-related indicators, and cystatin C among renal function indicators were all risk factors for thyroid antibody conversion (P < 0.05). In addition, several indicators in the blood count correlated with thyroid conversion (P < 0.05). Changes in the ratio of free thyroxine to free triiodothyronine were a risk factor for positive thyroid antibody conversion (ORfT4/fT3 = 1.763; 95% confidence interval 1.554–2.000). The area under the curve (AUC) of the early warning model based on the positive impact of clinical laboratory indicators, age, and sex was 0.85, which was validated by both internal (AUC 0.8515) and external (AUC 0.8378) validation. ConclusionsThe early warning model of anti-TPO and anti-Tg conversion combined with some clinical laboratory indicators in routine physical examination has a stable warning efficiency.

A detailed pituitary profile always matters

Abstract 29-year-old female with known hypothyroidism and positive thyroid auto antibodies, followed up throughout pregnancy for adjusted doses of thyroid replacement therapy, presented 2 months post-partum with gradually increasing fatigue, repeated pre-syncope experience, inability to cope with daily home and family needs and headache. Adequacy of thyroid replacement therapy was questioned, TSH has been performed: 0.18 mIU/ml. Checking the blood pressure in lying and standing position has showed Postural hypotension. An urgent measurement of Cortisol (am) showed a result of1.06 ug/dl. Preliminary Differential Diagnoses have been suggested; Pituitary apoplexy, Pituitary adenoma, Autoimmune adrenalitis (Autoimmune Polyglandular Syndrome) or Others. On further detailed history, the patient affirmed dizziness and fainting liability on standing from lying position, bitemporal headache more in the morning. However, she denied frequent urination throughout the day, neither repeated times at night. In addition, she confirmed efficient breast feeding. Continued Lab investigations: ACTH (am) (Low); FT4 (Low; on replacement therapy); IGF1 (Normal) Serum osmolality (Normal); Urine osmolality (Normal); E2 / LH / FSH (normal physiological levels) Prolactin (normal for breast feeding) MRI pituitary and sella: Diffuse isointense enlargement of anterior pituitary gland. Homogenous and strong diffuse pituitary enhancement with gadolinium contrast. History and investigations were not fully matching with any of the previously proposed differential diagnoses, especially in regards of selective corticotroph and thyrotroph affection, sparing other pituitary cell types. Moreover, the autoimmune predisposition, the nature of the clinical presentation and its timing during early postpartum period, together with the laboratory and imaging investigations were all matching with the diagnosis of Lymphocytic Hypophysitis. The Patient got pregnant again 14 months post-partum, reflecting spared gonadotroph function and highlighting the importance to identify this uncommon diagnosis and to notify the patient about normal gonadal function and the normal possibility of pregnancy. However, she remained on hydrocortisone and thyroxine replacement. Finally, it is important that this condition should not be misdiagnosed in the first place as postpartum thyroid disturbance and TSH results, especially during and after pregnancy, shall always be interpreted in the clinical context and with the overall thyroid profile.

Intravenous immunoglobulin as a source of passively acquired thyroid autoantibodies

Introduction: Several cases of newly positive thyroid autoantibodies (TA) following intravenous immunoglobulin (IVIG) administration were noted at ACT Pathology, prompting investigation into the presence of TA in IVIG solutions.

Comparison of inflammatory markers in euthyroid patients with positive and negative thyroid autoantibodies

Comparison of inflammatory markers in euthyroid patients with positive and negative thyroid autoantibodies

Cut-offs for thyroid peroxidase and thyroglobulin antibodies in early pregnancy.

Thyroid disease in women of reproductive age is mainly of autoimmune origin, and thyroid peroxidase antibodies (TPO-Ab) as well as thyroglobulin antibodies (Tg-Ab) are key markers. Adding to this, much focus in pregnancy is on euthyroid women who are thyroid antibody positive. Evidence to substantiate the cut-offs for the definition of thyroid autoantibody positivity in early pregnant women is warranted. Stored serum samples from 14,030 Danish pregnant women were used for the measurement of TPO-Ab, Tg-Ab, TSH, and free thyroxine (ADVIA Centaur XPT, Siemens Healthineers). Among all women, a reference cohort of 10,905 individuals was identified for the establishment of antibody cut-offs. Percentile cut-offs for TPO-Ab and Tg-Ab were determined using regression on order statistics (the reference cohort). The established cut-offs were then applied (the full cohort), and frequencies of early pregnancy as well as later diagnosis of hypothyroidism were evaluated. The highest established cut-offs (95th, 97.5th, and 99th percentiles) were 59, 68, and 81 U/mL for TPO-Ab and 33, 41, and 52 U/mL for Tg-Ab. When the cut-offs were applied in the full cohort, 11.0, 10.2, and 9.7% were TPO-Ab positive, whereas 13.3, 12.3, and 11.2% were Tg-Ab positive. Antibody-positive women (TPO-Ab and/or Tg-Ab) had higher median TSH and were more likely to have hypothyroidism in early pregnancy and to be diagnosed with hypothyroidism during follow-up. This large study established and evaluated pregnancy-specific cut-offs for TPO-Ab and Tg-Ab. The findings are important regarding the classification of exposure in pregnancy and assessment of thyroid autoimmunity per se.

ODP570 Immunotherapy and its Implications for the Future of Endocrinology: A Case Discussion of Pembrolizumab Induced Myxedema Coma

Abstract Introduction Immunotherapy is a relatively new type of cancer treatment that has been successful in prolonging survival time and improving quality of life for patients with a wide variety of cancers.1 While these therapies do not usually have the same systemic toxicities seen in traditional chemotherapies, they can lead to significant autoimmune disorders due to their method of action.2 We present a case of pembrolizumab induced Hashimoto's thyroiditis leading to myxedema coma. Case A 67-year-old male presented to the hospital ED via EMS after being found unconscious in his car by his neighbor. On arrival, he was confused, lethargic, unable to answer questions, and had a Glasgow Coma Scale of 12. He was hypotensive 87/55 mmHg, bradycardic 55 bpm, respirations 12 breaths/min, SpO2 99% on room air, temperature 37 °C. Past medical history included type 2 diabetes mellitus on insulin and non-small cell lung cancer metastatic to bone and brain treated with pembrolizumab, denosumab, steroids, and radiation therapy. Initial labs revealed elevated TSH of 47. 01 with undetectable T3 and T4, glucose 514 mg/dL and elevated beta hydroxybutyrate 1.61, WBCs 3.9, hemoglobin 11.7, platelets 105. TPO antibodies were elevated 44.5IU/ml. Patient was treated with IV levothyroxine, hydrocortisone, insulin, and fluids and his condition improved rapidly. Patient was transitioned to oral levothyroxine with plans for outpatient endocrinology follow upon discharge. Thyroid tests done during a prior hospitalization following the initiation of pembrolizumab six months earlier demonstrated a low TSH of &amp;lt;0. 003 and an elevated free T4 of 2. 09. The diagnosis of autoimmune thyroiditis induced by immunotherapy was made. Discussion Pembrolizumab is one of several immune-checkpoint inhibitors (ICIs) used to treat cancer by blocking the programmed-death (PD-1) receptor, allowing T-cells to detect malignant cells and mount an immune response. ICIs are part of a larger therapeutic class known as immunotherapy which acts to enhance the body's own detection and elimination of cancerous cells.1 As a result, approximately 10% of patients treated with immunotherapy develop autoimmune reactions.2 In this case, the patient had positive thyroid autoantibodies for Hashimoto's thyroiditis, that eventually lead to his profound hypothyroid state and myxedema coma. As these therapies become more widely utilized, the incidence and prevalence of autoimmune induced endocrine disorders will naturally increase. Awareness of the mechanisms and implications of immunotherapy in patients presenting with endocrine disorders will led to early recognition, treatment and improved patient outcomes. Waldman AD, et al Nat Rev Immunol. 2020;20(11): 651-668. Barroso-Sousa R, et al. . JAMA Oncol. 2018;4(2): 173-182. Presentation: No date and time listed

The findings about relationship between autoimmune thyroid disease and first-trimester aneuploidy results

Aim: The aim of this study was to investigate the relationship between thyroid autoantibody and first-trimester aneuploidy results. Thyroid autoimmunity (TAI) is the most common autoimmune disorder. Patients with TAI are usually euthyroid. Thyroid peroxidase (TPO-Ab) in patients with or without thyroid dysfunction is associated with infertility, recurrent embryo implantation failure, and early pregnancy loss. The impact of TPO-Ab on first-trimester aneuploidy test results needs to be studied.&#x0D; Material and Method: This retrospective case-control study was conducted between December 2019 and May 2022. Patients with thyroid autoantibody positivity (n=112) were included in the study as the case group. The control group was selected from age and body mass index (BMI)-matched patients (n=130). Nuchal translucency (NT), crown rump length (CRL), pregnancy-associated plasma protein A (PAPP-A) and free beta subunit of human chorionic gonadotropin (β-hCG)) values were compared between the two groups.&#x0D; Results: This study included two hundred forty two age-matched (29.86±4.51) and BMI-matched (23.96±2.34) women. There was no statistically significant difference between groups in terms of free thyroxine (FT4), PAPP-A and free β-hCG (p&gt;0.05). NT as a marker for major chromosomal defects and CRL were comparable in case and control groups (p&gt;0.05).&#x0D; Conclusion: There is no statistically significant relationship between thyroid autoimmune diseases and the first-trimester aneuploidy results.

Thyroid Function Rather Than Thyroid Antibodies Affects Pregnancy and Perinatal Outcomes: Results of a Prospective Study.

Thyroid autoantibody positivity has been associated with an increased rate of obstetrical complications. We aimed to evaluate the role of thyroid autoantibodies in adverse pregnancy outcomes. This prospective study was conducted in the Endocrinology Unit of Pisa Hospital. A total of 975 pregnant women were studied from 2012 to 2021; 572 (59%) were diagnosed with autoimmune thyroid (AT) diseases; 403 (41%) served as controls. Levothyroxine (LT4) treatment was introduced when TSH was > 2.5 mIU/L in the AT group and when TSH was > 4 mIU/L in the controls. Rates of obstetrical complications in each group were measured. Although the frequency of miscarriage in the AT group was greater (4.8%) than in the controls (2.9%), no significant differences were detected (P = 0.181). There were no differences between the 2 groups concerning the other pregnancy complications, and no association with the titer of thyroid antibodies was observed. The frequency of congenital malformations was greater in the AT group than in the controls (P = 0.019), but no correlation with major congenital malformations was detected (P = 0.872). Given that thyroid hormone concentrations were strictly controlled in our population, we documented a tendency (not significant) toward an increase in miscarriage and preterm birth among women with TSH > 4 mIU/L. If thyroid function is adequately controlled, the presence and titer of thyroid autoantibodies does not negatively influence gestation. Although not significant, suboptimal thyroid hormone status seems to affect pregnancy outcomes more than thyroid autoimmunity.

Impact of anti-thyroid peroxidase and anti-thyroglobulin antibodies on the gestational outcome of euthyroid pregnancies: A retrospective study.

Thyroglobulin (anti-TG) and/or thyroid peroxidase (anti-TPO) autoantibodies are associated with higher rates of poor gestational outcomes. To demonstrate the impact of anti-TPO and anti-TG autoantibodies on the gestational outcomes of euthyroid pregnant women with a history of poor gestational outcome and thyroid gland disorders. This retrospective study included totally 75 euthyroid pregnant, 30 of women with high thyroid autoantibodies (Anti-TPO/Thyroglobulin-positive group) and 45 of them without autoantibodies (control group). We could not demonstrate significant differences between two groups in terms of risk factors/co-morbidities, obstetric complications, gestational outcomes, and birth data (p> 0.05). However, enhanced miscarriage rates were observed among the Anti-TPO/Thyroglobulin-positive and control groups without significance (36.7% and 17.8% respectively, p= 0.116). High neonatal intensive care unit (NICU) admission rates were found for control and Anti-TPO/Thyroglobulin-positive groups (16.2% and 21.1%, respectively) (p= 0.720). Clinically, we compared the two groups in terms of the existence and the types of goiter (diffuse and nodular), and demonstrated that nodular goiter was statistically more frequent in the control group (40.0% vs. 8.7%, p= 0.015). Alongside, relatively high hereditary thrombophilia and type-2 diabetes mellitus rates were found in the Anti-TPO/Thyroglobulin-positive group (20.0% and 20.0%). Thyroid autoantibody positivity is likely a risk factor for early pregnancy loss and NICU admission.

Comparison of the Patients with Chronic Urticaria Who Responded and Did Not Respond to Omalizumab Treatment: A Single-Center Retrospective Study

Introduction: Chronic urticaria (CU) is a condition usually lasting longer than 6 weeks, with wheals and angioedema, sometimes both. Omalizumab is a recombinant humanized monoclonal IgG antibody developed against IgE. In some patients with CU, treatment response to omalizumab is good, but in some patients, it is poor. We aimed to compare the clinical features and laboratory parameters of the patients who responded and did not respond to omalizumab treatment among patients diagnosed with CU. Methods: Patients treated with omalizumab for the diagnosis of CU were evaluated retrospectively. Treatment response to omaliz­umab was evaluated by urticaria control test (UCT) (responder to omalizumab: UCT score ≥12 at 6 months and an increase of ≥3 compared to baseline). The clinical features and laboratory parameters of the patients who responded and did not respond to treatment were compared. Results: The mean age of the 220 patients, 66 (30%) men and 154 (70%) women, who received 300 mg of sc omalizumab every 4 weeks for CU was 38.89 ± 12.76 years. One hundred eighty-nine (85.9%) patients had good response to omalizumab treatment at the end of 6 months. Atopy (n = 73 [38.6%], p = 0.026), eosinophil count (median = 190 [0–800] [cells/µL], p < 0.001), basophil count (median = 40 [0–100] [cells/µL], p = 0.021), and total IgE (median = 240.5 [45–2,644] [kU/L], p < 0.001) level were significantly higher in the omalizumab responder patients (UCT score ≥12 at 6 months and an increase of ≥3 compared to baseline). Psychiatric disorders (n = 13 [41.9%], p = 0.008) and anti-TG (n = 11 [35.5%] [>2 IU/mL positive], p = 0.024) were significantly higher in the oma­lizumab nonresponder patients (UCT score ≤11 at 6 months). A weak but significant clinical correlation was found between blood eosinophil count (r = 0.168, p = 0.013), blood lymphocyte count (r = −0.149, p = 0.027), total IgE level (r = 0.207, p = 0.002), and increase in UCT score. As a result of the ROC curve analysis, the blood eosinophil count (AUC: 0.763, p < 0.001), total IgE level (AUC: 0.866, p < 0.001), and blood basophil count (AUC: 0.662, p = 0.004) had diagnostic value in predicting the response to omalizumab treatment in patients with CU. Conclusion: The patients with CU who were atopic with high eosinophils, high basophils, and high total IgE levels had good response to omalizumab treatment, but the patients with concomitant psychiatric disease and positive thyroid autoantibodies had poor response to omalizu­mab treatment. These findings obtained in our study should be tested in randomized controlled studies.

An Investigation on the Risk Factors of Thyroid Diseases in Community Population in Hainan.

Background In recent years, the incidence of thyroid diseases has increased significantly, which has seriously affected people's work and life. The purpose of this study was to explore the epidemiological characteristics of thyroid diseases and autoantibodies. Method According to the principle of overall sampling, resident residents ≥18 years and who will not move within 5 years are randomly selected. A total of 2136 eligible individuals were divided into case and control groups according to whether they have thyroid disease. Finally, the impact of potential risk factors on thyroid diseases was evaluated. Results The overall prevalence of thyroid disease was 58.3%, and there was a significant difference in the prevalence of thyroid disease between women and men (p = 0.004). Except for the age group ≥70 years, with the increase in age, the prevalence gradually increased (p < 0.05). Participants with positive thyroid autoantibodies (TPOAb or TgAb) had a higher prevalence than participants with negative autoantibodies. The positive rate of autoantibodies in women was higher than that in men (p < 0.05). UIC (p = 0.004) and free thyroid hormone (FT4) (p = 0.001) levels of men were higher than those of women, and the TSH level of women was higher than that of men (p = 0.002). The regression analysis showed that women, older age, and family history of thyroid disease were independent risk factors for thyroid disease. Conclusion The prevalence of thyroid diseases in Hainan was high. Women are more susceptible to thyroid disease than men, and the prevalence increased with age.